Inmates sterilized without state OK

Crystal Nguyen, with her 6-year-old son, Neiko, in Pittsburg, Calif., is a former Valley State Prison for Women inmate. She worked in the prison's infirmary in 2007 and says she often overheard medical staff asking inmates who had served multiple prison terms to agree to be sterilized.
Noah Berger/For The Center for Investigative Reporting

Crystal Nguyen, with her 6-year-old son, Neiko, in Pittsburg, Calif., is a former Valley State Prison for Women inmate. She worked in the prison's infirmary in 2007 and says she often overheard medical staff asking inmates who had served multiple prison terms to agree to be sterilized.

“Do I criticize those women for manipulating the system because they’re pregnant? Absolutely not,” Martin, 73, said. “But I don’t think it should happen. And I’d like to find ways to decrease that.”

Martin denied approving the surgeries, but at least 60 tubal ligations were done at Valley State while Martin was in charge, according to the state contracts database.

Federal and state laws ban inmate sterilizations if federal funds are used, reflecting concerns that prisoners might feel pressured to comply. California used state funds instead, but since 1994, the procedure has required approval from top medical officials in Sacramento on a case-by-case basis.

Yet no tubal ligation requests have come before the health care committee responsible for approving such restricted surgeries, said Dr. Ricki Barnett, who tracks medical services and costs for the California Prison Health Care Receivership Corp.

The receiver has overseen medical care in all 33 of the state’s prisons since 2006, when U.S. District Judge Thelton Henderson ruled that the system’s health care violated the constitutional ban on cruel and unusual punishment.

The receiver’s office was aware that sterilizations were happening, records show.

In September 2008, the prisoner rights group Justice Now received a written response to questions about the treatment of pregnant inmates from Tim Rougeux, then the receiver’s chief operating officer. The letter acknowledged that the two prisons offered sterilization surgery to women.

But nothing changed until 2010, after the Oakland-based organization filed a public records request and complained to the office of state Sen. Carol Liu, D-Glendale. Liu was the chairwoman of the Select Committee on Women and Children in the Criminal Justice System.

Prompted by a phone call from Liu’s staff, Barnett said the receiver’s top medical officer asked her to research the matter. After analyzing medical and cost records, Barnett met in 2010 with officials at both women’s prisons and contract health professionals affiliated with nearby hospitals.

The 16-year-old restriction on tubal ligations seemed to be news to them, Barnett recalled. And, she said, none of the doctors thought they needed permission to perform the surgery on inmates.

“Everybody was operating on the fact that this was a perfectly reasonable thing to do,” she said.

Risk factors

Martin, the Valley State Prison medical manager, said she and her staff had discovered the procedure was restricted five years earlier. Someone had complained about the sterilization of an inmate, Martin recalled. That prompted Martin to research the prison’s medical rules.

Martin told CIR that she and Heinrich began to look for ways around the restrictions. Both believed the rules were unfair to women, she said.

“I’m sure that on a couple of occasions, (Heinrich) brought an issue to me saying, ‘Mary Smith is having a medical emergency’ kind of thing, ‘and we ought to have a tubal ligation. She’s got six kids. Can we do it?’ ” Martin said. “And I said, ‘Well, if you document it as a medical emergency, perhaps.’ ”

Heinrich said he offered tubal ligations only to pregnant inmates with a history of at least three C-sections. Additional pregnancies would be dangerous for these women, Heinrich said, because scar tissue inside the uterus could tear.